MEDICARE: DARLA O'BRIEN MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	5039	LA
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1407357759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLA O'BRIEN MA, LPC

Provider Business Mailing Address
First Line	:	9000 W WILDERNESS WAY APT 25
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-6832
Country	:	US
Telephone Number	:	318-464-5376
Fax Number	:

Provider Business Practice Location Address
First Line	:	8504 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-6146
Country	:	US
Telephone Number	:	318-464-5376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	08/26/2022

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